IntroductionThe diagnostic, predictive and prognostic role of anti-cyclic citrullinated peptide (CCP) antibodies in rheumatoid arthritis (RA) patients is widely accepted. Moreover, detection of these antibodies in subjects presenting with undifferentiated arthritis (UA) is associated with a significant risk to develop the disease. On the other hand, clinical and prognostic significance of evaluating anti-CCP levels in subjects with inflammatory arthritis at disease onset has not been fully clarified. The goal of this prospective study is to analyze the value and prognostic significance of anti-CCP titer quantification in UA subjects.MethodsSerial anti-CCP assays were measured in 192 consecutive patients presenting with UA lasting less than 12 weeks. Clinical and serological data and arthritis outcome were evaluated every 6 months until two years of follow-up.ResultsAnti-CCP positivity, at both low and high titer, and arthritis of hand joints significantly predicted RA at two years, risk increasing in subjects with high anti-CCP titers at baseline. Moreover, time to RA diagnosis was shorter in patients with high anti-CCP2 titers at enrollment with respect to those with low antibody concentration.ConclusionsPresence of anti-CCP antibodies, at both low and high concentration, is significantly associated with RA development in subjects with recent onset UA. However, time interval from the onset of the first symptoms to the fulfilment of the classification criteria appears to be directly related to the initial anti-CCP level.

Objective: To determine the prevalence of metabolic syndrome (MS) in a primary care pediatric setting and to collect clinical and biochemical data, allowing for a prediction of its presence in a supposedly healthy population. Methods: Belonging to a pediatric population followed by pediatricians of the Italian National Health Service, 415 subjects with obesity as a unique selection criterion were enrolled. The entire cohort was screened for MS, which was defined as the presence of at least 2 other findings out of obesity: fasting hyperglycemia, low levels of high-density lipoproteins cholesterol, hypertriglyceridemia, and hypertension. Results: The overall prevalence of MS was 30.8%. Major findings (out of obesity) were low high-density lipoproteins cholesterol levels (46.2%), hypertension (23.6%), hypertriglyceridemia (22.2%), and fasting hyperglycemia (16.6%). Waist-to-height ratio was the only clinical parameter directly related to MS, with the same predictive power of insulin resistance. Conclusions: Metabolic syndrome can be present in a significant percentage of ''healthy'' obese children, and a simple clinical parameter could identify at-risk subjects. This observation justifies the development and implementation of pediatric networks for obesity screening programs. JPGN 49: 329-334, 2009.

There is a growing interest in using monoclonal antibodies (mAbs) in the early stages of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection to prevent disease progression. Little is known about the efficacy of mAbs against the delta variant of concern and its clinical presentations. We evaluated the effect of casirivimab/imdevimab treatment among five delta vaccine breakthrough patients. Symptomatic non-hospitalized vaccinated patients were submitted to nasopharyngeal swabs for the detection of SARS-CoV-2 and Next-Generation Sequencing (NGS). Blood analysis and chest Computed Tomography were also performed. A cocktail of casirivimab/imdevimab was administrated, and patients were monitored weekly. Clinical evolution was evaluated by the regression of the symptoms, negative results by real-time RT-PCR, and by the need of hospitalization: these aspects were considered as significant outcomes. In four cases, symptom reversion and viral load reduction were observed within 2 days and 7 days after mAbs treatment, respectively. Only one case, suffering from thymoma, was hospitalized 2 days later because of respiratory failure, which reverted within 18 days. mAbs treatment seems to be safe and effective against the delta variant and its clinical manifestations.

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